2. INTRODUCTION
• A moderate decrease in factors II,VII,IX & X occurs in all
newborns by 48-72 hrs after birth, with a gradual return to birth
levels by 7-10 days of age
• Transient deficiency of Vitamin K-dependent factors is due to
lack of free Vitamin K in the mother & absence of intestinal flora
responsible for synthesis of Vitamin K.
3. HDN CONT’
• Breast milk is a poor source of Vitamin K
• hemorrhagic complications appear more frequently in breast-fed
than in formula-fed infants
4. HDN CONT’
• Early-onset life threatening Vitamin K deficiency-induced
bleeding(onset from birth-24hrs) also occurs if the mother has
been treated with drugs(phenobarbital ,phenytoin) that interfere
with Vitamin K function.
• Late onset(> 1 wk) is often associated with Vitamin K
malabsorption,as noted in neonatal hepatitis or biliary atresia.
5. PRESENTATION
CLASSIC DISEASE;
• Occurs on day 2-7 of life
• Bleeding that tends to be git, ENT, injection sites, subcutaneous,
intracranial, or due to circumcision
Laboratory Findings
• PT,PTT, coagulation time are prolonged
• levels of prothrombin(II) & factors VII,IX, and X are decreased
• Bleeding time, fibrinogen, factors V and VIII, platelets, capillary
fragility, and clot retraction are normal for maturity
6. PREVENTION
• I/M adminstration of Vitamin K Img at birth, prevents the
decrease in Vitamin K-dependent factors in FT infants, but not
uniformly effective in preterms.
7. • A particularly severe form of deficiency of Vitamin K-dependent
coagulation factors has been reported in infants born to mothers
receiving anticonvulsant medications(Phenobarbital
&Phenytoin).This bleeding is usually corrected by Vitamin
K,although response in some is poor or delayed.If PT is
prolonged in this scenario,give fresh frozen plasma.
8. DIFFERENTIALS OF
HEMORRHAGIC DISEASE OF THE
NEWBORN
1.Congenital defects of blood coagulation-
hematomas, melena & post circumcision &
umbilical cord bleeding may be present. Rx
requires fresh frozen plasma or specific factor
replacement.
2.DIC in the newborn results in consumption of
coagulation factors & bleeding, Rx is directed at
correcting the primary clinical problem e.g
Infection & interrupting consumption &
replacement of clotting factors.
9. DIFFERENTIALS
3.Swallowed blood syndrome=blood or bloody stools
passed, usually on 2nd or 3rd day of life,may be
confused with with hemorrhage from the git.The
blood may be swallowed during delivery or from a
fissure in the mother’s nipple.Differention from GIT
hemorrhage is that the infant’s blood contains
mostly fetal Hb, which is alkali resistant, whereas
swallowed blood from a maternal source contains
Adult Hb ,which is promptly changed to alkaline
hematin after the addition of alkali.(Apt test)
10. DIFFERENTIALS
• 4.Neonatal thrombocytopenic purpura.=NB. Thrombocytopenia
in the newborn rarely is indicative of a primary disorder of
megakaryopoeisis, but most often is the result of systemic
illness(e.g TORCH,gram –ve bacilli) or transfer of maternal
antibodies directed against fetal platelets.
